Some signs of high BGLs include: increased thirst, weeing more than usual, poor concentration, irritability and tiredness. High BGLs with raised ketones needs immediate treatment.

Things that may have caused the glucose levels to be high include;

Missed insulin
Increase in appetite without an increase in insulin doses
Less physical activity without an increase in insulin doses e.g. school holidays
High GI foods
Overtreatment of hypos
Stress or illness

A recap on ketones                                                                                                                        

• Insulin allows glucose to move into the body’s cells to give energy
• Ketones are made when the cells do not have enough glucose
• Ketones can be made during a vomiting illness associated with normal or low BGLs. The treatment for this is high GI glucose, such as drinking lemonade or taking glucose tablets
• Ketones + high BGLs is usually associated with missed doses of insulin but also occurs during illness
• High ketone levels can cause diabetic ketoacidosis (DKA). DKA is a medical emergency and if left untreated is life threatening
• Some signs or symptoms of high ketones are vomiting, “acetone” smelling breath, abdominal pain, changed conscious state and rapid breathing
• High ketone levels=
• 0.6 mmol/L or higher if using an insulin pump or
• 1.0 mmol/L or higher if using insulin injections or
• ++ or +++ ketones on urine test. If any change in colour on urine test, you should check blood ketone level if available

What to do if the BGL is 15mmol/L or higher

Check ketone levels using either urine ketone strips or blood ketone strips. Having access to ketone checking can assist in early treatment of illness or insulin omission and can help prevent the need for a hospital presentation

Action if BGL is 15 mmol/L or higher and ketones are high

Managing ketones if using injected insulin via pen or syringe 

Managing ketones if using an insulin pump 

Action if BGL is 15 mmol/L or higher and ketones are not high

• Continue normal activity
• Drink 1-2 glasses of water
• If using an insulin pump, enter the BG and accept the correction. Check your BGL again in 2 hours
• If using a dosing card and injections and you have not given rapid acting insulin within the last 3 hours, follow the dosing card advice for a correction. Check your BGL again in 2 hours
• Record your BGLs in a record book; you may need a change to your insulin doses if your BGL is high at a similar time each day
• Check if there is an obvious reason for the high BGL. If there is one, make a note in your record book

If you are experiencing lots of high BGLs despite following this advice, we suggest you contact your diabetes team for further support